We want your experience to be pleasant and informative. It has been 30 years since I received my doctorate from the University of Texas and I do not claim to know everything. I do believe that healing requires the integration of body, mind and spirit and inflammation drives much of the heart & vascular disease. This does not mean we abandon Evidence-Based Medicine and current guidelines. Clients often will be taking multiple over-the-counter supplements, many of which lack any safety or efficacy data to support, yet desire to spend our visit complaining about prescribed medications and perceived side effects. 

​

Evidence-Based Medicine is a blend of the best evidence and clinical expertise with patient values and preferences in pursuit of the best possible outcomes. I understand clients will read and hear things from various media sources and I want you to stay informed; however, don't miss the science.  If a client has significant heart and vascular disease, we need to address, not only lifestyle modification, but blood pressure, lipids and inflammation.  Some clients will offer me a speech on the dangers of Chantix while continuing to smoke packs of cigarettes daily. We must be willing to think logically and follow the best evidence possible.  I will not argue that I know everything and current belief is sometimes replaced years later. That is the art and science of medicine.  

​

Medicine is not always black and white. There are certainly areas that are grey or we just don't know. Dr. Tricoci and colleagues at Duke Medical Center, found that cardiology guidelines were based largely on weak evidence of expert opinion with only 19% of guidelines having level A evidence (good science well-studied!) to back the recommendations.  

​

People often want to tell me what they've heard about statins. I read everything that I can, both good and bad. All drugs have effects and no one is denying that fact, but heart and vascular disease are the number one killer of people. Often our lifestyle has dangerous side effects and we ignore this aspect of our journey to better heart & vascular health.  

A recent client survived breast cancer treatment only to have a heart attack at age 45. She refused to take a statin due to perceived side effects she read about online.  She was working hard to change her diet, exercise more regularly and reduce stress in her life. She was taking her blood pressure medications and aspirin, but simply did not want to take a statin. It is not my position to force anyone to do something they wish to avoid, but I will make certain you understand the indication and possible outcome if you do not follow the guielines. 

Once she was willing we discussed the studies in Europe demonstrating a significant reduction in recurrent breast cancer in those women taking statins. What? Yes, a 14-year study in more than 1 million people found that statins are associated with lower rates of breast cancer and subsequent mortality. The women with high cholesterol had a 45% reduced risk of breast cancer, and if they did develop breast cancer, a 40% reduced chance of death.  * see European Society of Cardiology - 2017, "Statins linked to lower rates of breast cancer and mortality."  She decided to take a statin and work on lifestyle and has done fine. It is important to follow and monitor labs to make certain one is tolerating therapy. Her greatest risk is still dying from a heart attack. Heart & vascular disease are responsible for killing more women than cancer.  It is important to know you risk and get sound advice.  

​

Preventive Cardiology is about trying to put the odds in your favor. No one can guarantee that any advice or treatment plan will prevent a heart attack or stroke. It is not that simple and multiple factors are at play.  I must admit that I do not believe pills in the absence of real lifestyle modification works to prevent disease. Medications are typically crutches until you get it right.  Taking diabetic medications, but refusing to follow a diet like Joel Fuhrman's The End of Diabetes or at least accepting the basics of a diabetic, anti-inflammatory diet, probably does not work for most people. Diabetes care is about more than just lowering blood sugar levels.  

​

I am not a Concierge Physician and I understand many of you are followed by a concierge clinic. This clinic is still based on the insurance model and must make certain we have approval for your visits. A number of my clients have or retain their cardiologist as well. This is fine. I do not mind working with other cardiologists and blending my recommendations with their treatment plan.  We have no problem seeing clients for a second opinion or you seeking other opinion after our visit. You are the key person and we want to make certain you get the best care possible.

​

We often have students from a number of university programs studying with us and you will enjoy their interactions as well.  My mentors taught me that the Art of Listening and physical examination are key to the proper diagnosis and treatment of individuals.  Every patient is important and time must be shared amongst all of them under the current insurance model. The current Healthcare climate has made the physician-patient interaction much more difficult, but if we work as a team, including you, it works must better. 

I want you to realize that your appointment time with me is your arrival time. It is often not the time you will begin your interaction with me. Once you arrive the staff will begin to verify insurance, gather and enter data into the electronic health record take vital signs and perform EKGs. I understand many travel a distance, but most plans do not allow us to see you in clinic for consultation and then perform testing on the same day. Some prefer to get testing performed the same day and pay cash, but since most required & necessary testing is covered I would usually recommend we schedule testing in the future or prior to the visit.  I did not create the rules of healthcare, but I am working to make the assessment more efficient within these restraints.  

​

If you are a new client, it is important that we have old records and that you basically prepare for this examination.  Think about the prior testing completed in the past and try to bring those records with you, I.e., laboratory testing, screening tests from companies like LifeLine, stress tests, screening exams or invasive procedures,heart catheterizationsor records from hospitalizations related to your heart and vascular system. Your visit may be delayed if we have to wait on key information. I expect you to have skin in the game. I do not desire clients to be passive. We will work together to reach your healthcare goals. I want you moving towards thriving and not simply surviving!  

​

If I am delayed, there was good reason, I don't play golf and will not tolerate angst from clients for things beyond my control. The stress of current medical practices can be harmful to physician's health and wellbeing and I have chosen to avoid. This is not a fast clinic, nor a general medicine clinic, we are focused on heart & vascular preventive medicine and will discuss lifestyle, stress, fitness, nutrition and other aspects of what YOU can do to improve your health. 

​

We want you happy and satisfied. We understand we don't fit every personality or demand. I have not yet decided if we will offer an Enhanced-access model at The Centre in 2018, but we are in discussion currently to determine if it will work with our patients. I have always tried to be inclusive and not exclusive in the care we offer to clients.  

​

If we work together and understand the goals, then we will both enjoy the interaction.  I explain to my students and residents that patient satisfaction is important, but it is not the top priority. There was a recent 10-year study at UCLA that was halted early after they found a 238% increase in mortality and a 146% increase in morbidity associated with those patients who were in the most satisfied groups. This often happens when the physician's focus is redirected to pleasing instead of actually providing honest opinion and care. If you are looking for a fast doctor who can speed through the day, please keep looking. That is not who I am or who I plan to be in the future.

​

Preventive care is not cheap. It never has been cheap. I expect you to have certain tests if I am to follow you. This will be directed based on each patient's age, risks, history and findings. I utilize CT calcium scores, carotid CIMTs, advanced lipid testing, inflammatory testing and sleep testing.  Some tests are considered preventive and not covered by insurance. I am not willing to argue about the nuances of insurance coverage nor have the time. I still require these tests and related data. You have car insurance. If you crash into a building it will usually pay for the damages, repairs and perhaps a new car. Your car insurance does not pay for oil changes, brake repair and general maintenance that helps to reduce the chances of your having an accident. At least mine doesn't. It is your responsibility to maintain your car and unfortunately most people take better care of the cars than their bodies. I've often felt it would be in the best interest of auto insurance companies to better screen drivers for sleep apnea, attention deficit disorder and road rage. This would probably make a major impact on insurance costs and traffic related injuries and deaths, but isn't the current practice. Current medical guidelines and insurance tend to be reactive than proactive or preventive. 

​

I want you to be familiar with mindfulness, breath work, yoga-based techniques, stress reduction and meditation and working to thrive, not simply survive until your next heart attack. I want to watch the video, The Last Heart Attack with Dr. Gupta and think you will enjoy reading Dr. Masley's book, The 30 Day Heart Tune Up.  You ultimately decide your path and I am not here to coerce anyone to follow my recommendations. This is your path and everyone is different.  

I added key concepts on this page for you to review to help you understand my philosophy in preventive heart & vascular medicine. You must understand that you will follow-up at times with my Advanced Practice Clinicians, Internal Medicine residents or CV Fellows at times, but they will be communicating with me as well.  There is not enough time in the day for me to follow every patient at every follow-up visit and this cannot be your expectation.

If you have any testing completed, we will try to give you basic results at the time. You should have a follow-up within 1-2 weeks after testing. If you do not hear from us within 1-2 weeks or cannot keep your follow-up for results of testing, you must contact us to get your results. Do not assume that any test result is "okay" until you hear the results from us. You must hear about your results whether normal or abnormal. If you miss your follow-up for results, you must make or reschedule a follow-up or call us to inquire about final recommendations.

Your health and treatment are important and we must work as a team. This is for your safety whether testing is completed in our facilities or an outside testing facility. We must follow thru until your evaluation is completed.  

​

More to come and I wish you all the best on your journey to better heart & vascular health. 

​

Stephen